The Terminal Miseries of Pregnancy

December 14, 2007

In the Third Trimester - Weeks 25 to Term

Pregnancy Back Pain

Q     I have had excruciating back pain for three weeks now. I am now 37 weeks. Why am I experiencing this pain?
A    Assuming it isn't related to labor (real, false, or otherwise), there are other causes for back pain near the end of pregnancy. A kidney infection, more common in pregnancy, can present with pain in the mid-back, slightly to the left or the right. Ligament pain, harmless, can hurt your lower back. Also, the weight gained in pregnancy causes additional strain on your spine, made all the worse by a change in your center of gravity--and the aches can come along big time. Hydronephrosis, a swelling of the tubes running urine from your kidneys to your bladder (the tubes are called ureters), can hurt almost as much as a kidney stone. The hydronephrosis is because the sheer weight of the baby compresses these tubes, causing the urine to back up, much like the extra tension on a garden hose between the faucet and where you're stepping on the hose. Gall bladder disease is more likely in pregnancy, because estrogen causes bile to sludge more. This pain can cause right shoulder blade pain. Also, right sided back pain can be a sign of a severe form of pre-eclampsia (toxemia), called HELLP syndrome, which is an extreme danger for the liver, and it's owner! Now that your head is swimming with all of these terrible possibilities, it's probably nothing more than the "terminal miseries of pregnancy." An obstetrician can rule out all of the other things with a single office visit.

Pubic Bone Pain

Question: I am in my 32nd week and getting sharp pains directly behind my pubic bone that are constant and accompany a lot of pressure, but no back pain. Is this labor? I can't stand up without this pain... Answer: From the "Terminal Miseries of Pregnancy" Department, this particular pain sounds like what's called symphysis pubis diastasis. Translated, this means that the joint between the two central pubic bones is opening a little. Progesterone, a hormone that rises considerably in pregnancy, relaxes this joint (as well as other joints--and the bowels too, causing the famous constipation of pregnancy). This opening up of the pelvic ring results in a larger circumference for the baby to pass through, increasing the chance of successful passage at the time of delivery. And since the pelvis is a ring structure, don't be surprised if the payback causes a crimping pain in the back, at the sacroiliac joints on either side of your lower middle back. Urinary tract infections can be pretty sneaky in pregnancy, so any midline pain may invite a urinalysis or urine culture. An exam of your cervix to check for premature dilatation, although unlikely, may be prudent as well. Diastasis can occasionally be very severe. I had a patient once who even needed traction! But the pain is almost always harmless to you, and certainly harmless to the baby. Physical therapists can work wonders when we obstetricians tell you with a wink that the cure for this is delivery--but you're not laughing. Insurance should pay for a visit to the physical therapist, so ask your OB to write a prescription for it.
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